Michael, age 17, with major depression, and family

By the middle of his junior year Michael was finding it nearly impossible to get through a day at school. He felt claustrophobic and out of control. He became physically ill in school and lost any motivation to do homework or see friends.

Although theater and being with friends was a passion — he felt increasingly removed from his interests. He had trouble sleeping at night, getting out of bed during the day, eating, concentrating, and making decisions. Despite his intelligence, curiosity and eagerness to learn, Michael had never been a big fan of school. He bristled at the structure and values of a school system that he felt emphasized high SAT scores, college admissions and future earnings.

Eventually, he went to his guidance counselor. "I think something's wrong," he told her, "because school shouldn't be this hard." Feeling suicidal, he says, was the "sign that something was really wrong."

His guidance counselor thought it might be depression. Michael was skeptical of the diagnosis at first. Depression suggested other issues than school, and I was convinced that school was the center of it," he said. His counselor helped Michael talk to his parents, Ronnie and Chris, and they consulted his pediatrician, who confirmed the diagnosis.

"This really caught us by surprise," said Ronnie. "We had no idea it was building up. Looking back we were in denial for a while, almost fighting him on it." She recalls thinking that Michael was being defiant, "acting out," when he stopped doing his homework, for example. In response she would ask him to "shape up."

His parents located a day treatment program, which Michael tried, but his depression continued "plummeting" and he was hospitalized. Over the next six months, says Ronnie, "we worked on finding the right combination of medications." and began talk therapy.

What works

Michael and his family credit many factors with his ability to manage depression. "People were impressed by how involved Michael was in his own care," says Ronnie. "He really didn't have any language to put around how he was feeling, but he went to meetings and appointments willingly, and he shared helpful information with his clinicians."

Michael's parents also got involved. "Much of our energy went into becoming as informed as we could," she says. She read about depression and talked to other parents, clinicians and school personnel. She found the Depression Wellness Guide for Parents and Teens useful too. "We found the guide early, when things were very unstable in our house," she says, and it helped her and Chris learn how to best talk to Michael. She realized that saying things like, 'Just snap out of it' wasn't helpful to him. The guide also got her thinking about defining success on an hour-by-hour -- and eventually, day-by-day- basis, which she found useful.

Michael takes medication and attends group and individual talk therapy. His parents helped him move to a less conventional school, and he has taken up nature photography. He talks a lot to his friends, who listen and support him. He is now able to tell others when he's not feeling good. In the past, he would mask his feelings. "If anything started to show, I would just say I hadn't had much sleep that night. I didn't want to be seen as the kid who complains all the time. I had always been unshakable and I got a lot of respect because of it. I was afraid that if I showed any cracks, people wouldn't want to deal with me."

Ronnie and Chris have experienced periods of dread. "We feared for Michael's safety, and we worried that since there's no one right answer to managing depression, were we really doing everything we could?" They also learned that Michael's younger sister Rachel had been keeping her own concerns about Michael's condition to herself. "We began to understand that depression impacts the whole family and that as a family we needed to learn to deal with the diagnosis, symptoms and treatment together," Ronnie says. Rachel now gives talks about depression in her middle school and sees her own therapist.

For Michael the biggest challenge has been that "when you're feeling good, you get caught up in that and think, 'I'm done; I'm finally better. But depression can still jump out at you and then it's that much worse because you think, 'Oh, I was so close to being better.' Sometimes it's hard to remember that it's something that goes away and that you still have to take your medicine even when you're feeling good."